I had weird cronic pain as well a few years ago.It varied from chronic back pain in my upper back to weird sensation that some one had just shoved their fist into my lung.It turned out to be a pinched nerve

Migs, which shoulder is it? Do you have any other symptoms such as pressure in your upper abdomen?

A lot of possibilities here (we need more info from you on your symptoms please):

by Nathan Wei, MD, FACP, FACR

This type of pain has many possible causes.

Referred pain- that is pain coming from sources elsewhere need to be considered. For instance, the pain associated with disorders of the esophagus, stomach (penetrating ulcer), and pancreas may cause pain under the right shoulder blade.

Any problem that causes irritation of the diaphragm can also cause shoulder blade pain. An example would be an ectopic pregnancy.

Pain from aortic dissection can also lead to referred pain to the upper spine and shoulder blades.

A viral respiratory infection could leave you with pleurisy (inflammation of the lining of the lung) that might cause pain in your back. Pneumonia and pulmonary emboli may also do this.

The most common “internal” cause for pain leading to the right shoulder blade is gall bladder disease.

The term for this is “biliary colic.”

Biliary colic is a steady or intermittent ache in the upper abdomen, usually under the right rib cage. It happens when gallstones interfere with the normal flow of bile from the gallbladder. Bile is a liquid that helps to digest fats. Under normal circumstances, bile is produced in the liver and stored in the gallbladder. When you eat a meal, bile passes from the gallbladder through the cystic duct and the common bile duct into the small intestine, where it mixes with partially digested food. If a gallstone blocks either of these ducts, the normal flow of bile into the intestine is disrupted. The muscle cells in the bile duct contract vigorously to try to move the stone, causing the pain of biliary colic.

A person with biliary colic usually complains of an ache or a feeling of pressure in the upper abdomen. This pain can occur in the center of the upper abdomen just below the breastbone, or in the upper-right portion of the abdomen near the gallbladder and liver. In some people, the abdominal pain spreads back toward the right shoulder blade. Many people also experience nausea and vomiting.

Because symptoms of biliary colic usually are triggered by the digestive system's demand for bile, they are especially common after fatty meals. The symptoms also can occur when a person who has been fasting suddenly breaks the fast and eats a very large meal.

After you describe your symptoms, your doctor will perform a physical examination, paying particular attention to the upper right portion of your abdomen (the area of your liver and gall bladder). Ultrasound, the same painless procedure used to produce pictures of babies in teh womb, will be used to produce pictures of your abdomen so your doctor can look for gallstones. Blood tests also may be ordered, especially if you have any fever or if your pain persists.

Most episodes of biliary colic pass after one to five hours. After the most intense pain passes, your abdomen may continue to ache mildly for about 24 hours.

Because biliary colic is usually related to gallstones, it can be prevented by controlling the risk factors for gallstones. Some of these risk factors, such as heredity, increasing age and pregnancy, are a normal part of life. Others, such as obesity and a high fat diet, are risk factors you can modify by eating a healthy diet and getting regular exercise.

At first, your doctor will prescribe pain medication and tell you to eat a fat free diet. If the biliary colic is recurrent or persistent, surgery to remove the gallbladder (cholecystectomy) usually is recommended. This procedure can be done through small incisions using an instrument called a laparoscope. The procedure usually requires only brief hospitalization. It is currently the most widely used treatment in people troubled by painful gallstones, because it is very effective and safe, with no complications in more than 90 percent of cases.

If surgery cannot be performed and symptoms of biliary colic are persistent, medication that dissolves gallstones may be used. However, this medication is expensive and can take two years to work. Also, only small stones will dissolve. Rarely, medication to dissolve gallstones is combined with shock wave lithotripsy, a procedure that uses carefully aimed shock waves to break up gallstones. However, in many people treated with medication and/or lithotripsy, gallstones tend to form again within a few years.

A growth on the ribs could cause discomfort and should be ruled out by an X-ray.

Disc herniation and arthritis in the neck can cause cervical radiculopathy (pinched nerve) and this can cause pain to be referred to the shoulder blades.

Pain in the upper or mid back can come from trigger points in the muscles of the back itself, naturally enough. These muscles include the erector spinae, multifidi, trapezius, infraspinatus, subscapularis, serratus posterior superior, rhomboids, latissimus dorsi and serratus posterior inferior.

Trigger points in the scalene muscles of the front and side of your neck can generate a constant irritating ache between your shoulder blades in your upper back. Very few people know that this is one of the very most common causes of back pain.

A trigger point in the serratus anterior muscle under your arm can cause a persistent middle back ache at the lower tip of your shoulder blade that even a trigger point expert can overlook.

Trigger points in the upper part of your rectus abdominis (stomach) muscle can be responsible for a band of pain across your mid back that will elude the best physicians, osteopaths and chiropractors. No kind of therapy applied to the back itself will relieve this pain.

Back pain occurring in the back below the left shoulder blade is also a common condition.

Because of the complex makeup of the shoulder joint, movements make the shoulder extremely vulnerable to sprains, strains, tears and inflammation of the capsules, muscles, ligaments and bursa that are involved in the make-up of the joint itself.

The shoulder joint is actually made up of three joints and one “articulation”, where the head of the humerus (the long bone of the upper arm), meets the articulation with the collarbone and the shoulder blade (scapula).

There are 4 main muscles that are involved in keeping the joint together and in the complex movements, whenever the arms are moved. There are of course many other muscles involved, however these 4 muscles play the major role in the integrity of the joint itself. As a group, they comprise the rotator cuff. It is these muscles that are most vulnerable to tears, strains, sprains and inflammatory processes.

Where the pain occurs will play an important role in the diagnosis of the condition itself. It is recommended that any individual with shoulder pain be evaluated by their physician. The evaluation will consist of various tests involving the movement of the arm through all range of motion (ROM), and neurological inspection to see if there is any nerve involvement. X-rays and MRI scans may be ordered.

The bursa is a small sack of fluid that allows the muscles to glide smoothly as they are flexed or extended. There are two areas where this bursa is located and they can become swollen, inflamed or even infected. In an acute bursitis, the patient generally complains on any movement of the arm, and is generally worse at night, with difficulty in sleeping on the affected side. Pain and tenderness is generally located on the point of the shoulder. An acute bursitis left untreated can develop into a chronic bursitis.

Pains that occur along the top of the shoulder, and radiate into the side of the upper arm into the deltoid muscle, and further down the arm, even into the fingers, may be related to nerve impingement (pinched nerve), which can originate in the neck (cervical spine). The pain can be very intense on any movement of the arm and any pressure along the distribution of the nerve pathway.

Pains that occur over the shoulder blade (scapula) area can be due to the large muscle (trapezius) and underlying smaller muscles that have gone into spasm. The spasm of the muscles can be brought on by overuse or trauma to the muscle. The muscle will develop a spasm or “trigger point” that often send radiating pains to sites far removed from the trigger points.

Pains that occur under the shoulder blade may signal a warning that the pain is not in the shoulder itself, but can be related to a pain from one of the organs in the body. The shoulder where the pain occurs can give the clue which of the organs are affected and causing the radiating pain into the shoulder. Pain under the left shoulder blade can be a signal that there is a problem with the stomach or other abdominal structures (ulcers, pancreatitis, ectopic pregnancy) or in the chest (myocardial infarction [heart attack], pericarditis, pleuritis, pneumonia, pulmonary embolus, aortic dissection).

There can of course be many other problems that can affect the shoulders and cause pain of minor or major proportions. Here are just some of those problems that are most apt to affect the shoulder:

1. Rotator cuff syndrome that can either be a strain/sprain, or a tear. 2. Muscles that are not part of the rotator group can be torn or strained. 3. Tendons and ligaments can be torn or strained. 4. Inflammation of the shoulder joint, due to a virus arthropathy. 5. Joint dislocations that are directly related to a trauma, such as in golf, tennis, squash, bowling, handball, football and basketball. It can occur in other scenarios such as a fall on the hand or elbow striking the ground. 6. Osteoarthritis of the shoulder joint. 7. Rheumatoid arthritis (RA) of the shoulder joint. 8. Fractures that are related to a direct trauma, or a fracture that is related to osteoporosis, and can be due to a very slight traumatic incident. In the osteoporosis individual, the fracture can occur spontaneously during a normal movement. 9. An inflammation of the bursa. 10. Cancer of the upper end of the humerus (sarcoma). 11. Cancer of the breast that can metastasize to the shoulder.

Pain in the spine area near the shoulder blade may also occur as a result of primary spine disorders such as degenerative disc disease and osteoporosis.

Obviously, the appropriate treatment depends on making the correct diagnosis.

Q: I have been having horrible pain in my mid back and under my right shoulder blade on and off for years. The pain is often very sharp, though normally it is a dull pain that radiates to my chest as well. It is keeping me from sitting in one position for longer than 10 minutes or so and often keeps me from sleeping.

Stretching seems to help, but only temporarily. I am 28 and a woman. When I was a child I saw a chiropractor regularly for a slight case of a convex spine (cannot remember the name of the condition, and it seemed to correct itself once I finished growing). I also tend to have asthma off and on, and when I have an asthmatic episode, my pain gets worse.

Concurrently, I also have horrible pain on and off in my right hip/back of my hip joint. It constantly feels like it needs to pop, but is always too tight. One chiropractor once told me that my joint was out of socket, but I am not sure because a) I am walking fine and b) it seems to worsen when I ovulate (I have scar tissue on my ovaries from cysts).

Unfortunately, I am a poor graduate student who does not have medical insurance. I could go to my school's health center, but fear they will simply prescribe pain meds and send me on my way.

Is there anything I might be able to do until I recieve insurance? (as in, any home therapy that wouldn't be risky?)

Thank you for your time!

A: Apart from hot showers to sooth the muscles, not really. It's likely that there is a mechanical issue at hand, and this needs to be addressed. There may be a supportive exercise or two that can be recommended, but not until an examination is performed to evaluate function of the area.

Truth be told, I don't know many chiropractors who would turn you away based on your inability to pay, especially as a college student. If you really want and need the care, you can get help. All you really need to do is ask.

Great that is so reassuring lol. It is a pain that starts at my rib cage and goes up under my left shoulder balde. Hurts when i cough, sneeze,breath deep. Also laying down hurts, wake up after 4 hours due to pain, sitting up inclined helps some. i'll think more

Member since Mar 2008 Mood: alexpgreene ...with a pain in the shoulder (

For a good few months now i have put up with a first a pain in my left shoulder blade that only occured when i sneezed gradually its got alot worse and i almost result to tears, i instantly try to lay flat to minimise the pain when sneezing or stand against the wall. Over the past week or so its been getting worse constantly aching through the day at all times even more so when sneezing and coughing, even some breaths. Over the past 2 days its been aching my lower neck. This is only the left side of my shoulder blade / upper back. Im not sure what it can be im only 25 and in good health bar this. I have an appointment to see my gp but am worried and hoping for some advice and thoughts on what this sounds like Thanks

Doctor's Answer

by Prem Pillay, MD

, Mar 31, 2008 04:59AMThis could be a symptom of a slipped disc in the neck or in the upper thoracic spine. I would recommend that you do see a GP and get a thorough spine examination done and perhaps an MRI scan.

Member Comments (6)

alexpgreene Female United Kingdom Member since Mar 2008 Mood: alexpgreene ...with a pain in the shoulder (

, Mar 31, 2008 05:33AMThank you i have seen my doctor and he thinks it pleurisy ?? im not so sure but due an xray this week what are your thoughts?

by nevermindu

, Apr 02, 2008 10:05AMTo: alexpgreene

alexpgreene Female United Kingdom Member since Mar 2008 Mood: alexpgreene ...with a pain in the shoulder (

Consulting a chiropractor is also a suggestion.I'v been seeing one for issues I have. I was having similar pain as you and when I went in,one of my ribs was out.He put it back in and I felt fine.I would have never guessed that it was my rib that was causing me such discomfort and pain.

by mari1234

, May 12, 2008 01:13PMTo: PREM PILLAY, MD.HI, I HAVE BEEN HAVING ACUTE PAIN IN BETWEEN MY SHOULDERS A WEIRD PAIN, ALSO MY SHOULDER HURT A LOT AND COUGHING ALOT IT'S LIKE A DRY COUGH MY NECK HURTS ME ALOT ALSO SOMETIMES i THINK IS CANCER IN THE LUNGS, THIS PAIN IN MY SHULDERS IS GETTING WORSE AND WORSE, PLEASE HELP, THE BAD THING IS THAT I DONT HAVE INS AS I CHANGE JOBS.

omg i might have pluerisy. This isn't getting better! I will go when my return comes in. I woke up in great pain. I really wish sometimes, that someone would literally fillet my back and set it back together correctly.

i would make a visit to your chiropractor - every so often i get a pain going down my neck to under my shoulder blade and if i wait to long it will go all the way down my back to the top of my leg - im pretty sure mine is an old injury that i reaggravate every so often (prolly using bad form trying to force a couple more reps if i had to guess ) but long story short i go c the chiro once or twice and take it easy for a few days and the pain is gone and im back to a full range of motion - hope this helps

Migs, calm the f**k down, Drkage maybe right, often sub-scapular pain (what you have) is correlated with a popped rip, it's pretty common. The problem lies is when you get it popped back in, it easily gets popped back out. Repete, once you pop it out, it's difficult to keep it in. Are you having a hard time breathing in deeply?